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Parkinson's disease
Parkinson's disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson's disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson's primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

The specific group of symptoms that an individual experiences varies from person to person. Primary motor signs of Parkinson’s disease include the following. Scientists are also exploring the idea that loss of cells in other areas of the brain and body contribute to Parkinson’s. For example, researchers have discovered that the hallmark sign of Parkinson’s disease — clumps of a protein alpha-synuclein, which are also called Lewy Bodies — are found not only in the mid-brain but also in the brain stem and the olfactory bulb. These areas of the brain correlate to nonmotor functions such as sense of smell and sleep regulation. The presence of Lewy bodies in these areas could explain the nonmotor symptoms experienced by some people with PD before any motor sign of the disease appears. The intestines also have dopamine cells that degenerate in Parkinson’s, and this may be important in the gastrointestinal symptoms that are part of the disease.
 * tremor of    the hands, arms, legs, jaw and face
 * bradykinesia or    slowness of movement
 * rigidity or    stiffness of the limbs and trunk
 * postural    instability or impaired balance and coordination

Contents

 * 1) CASE     STUDY
 * 2) CLASSIFICATION
 * 3) CAUSES
 * 4) SIGNS     AND SYMPTOMS
 * 5) risk     factors
 * 6) DIAGNOSIS
 * 7) PREVENTION
 * 8) PROGRESSION
 * 9) MEDICATION     AND SURGERY
 * 10) HISTORY
 * 11) AWARENESS:     FAMOUS PEOPLE WITH THE DISEASE,BOOKS AND MOVIES RELATED
 * 12) REFERENCES
 * 13) EXTERNAL     LINKS

CASE STUDY
NAME : shekar borgonkar

AGE: 65

GENDER : male

The patient was diagnosed with Parkinson's on 15th February 2006 when he was 56 years old. First the tremors started in his left hand and after a year his right hand was affected too. He didn't opt for medication for almost 3 years. By then the tremors had worsened. the other symptoms included slurred speech, dementia, loss of reflexes, loss of balance. The tremors in his hands increased when he got anxious, or irritated. The medication included a tablet "syndopa plus" which is a precursor to dopamine. Dopamine cant be taken directly into the body as it cannot pass the blood brain barrier and enter the susbstangia nigra so a precursor is given to trick the brain into producing more dopamine. He also opted for ayurvedic medicine - zendopa and took velvet beans which decreased the tremors. There has been a diagnosis of Parkinson's in his family. His maternal grandparent had showed the symptom of tremors in his right hand

CLASSIFICATION
The term parkinsonism is used for a motor syndrome whose main symptoms are tremor at rest, stiffness, slowing of movement and postural instability. Parkinsonian syndromes can be divided into four subtypes, according to their origin: 4.      multiple system degeneration Parkinson's disease is the most common form of parkinsonism and is usually defined as "primary" parkinsonism, meaning parkinsonism with no external identifiable cause.In recent years several genes that are directly related to some cases of Parkinson's disease have been discovered. As much as this conflicts with the definition of Parkinson's disease as an idiopathic illness, genetic parkinsonism disorders with a similar clinical course to PD are generally included under the Parkinson's disease label. The terms "familial Parkinson's disease" and "sporadic Parkinson's disease" can be used to differentiate genetic from truly idiopathic forms of the disease
 * 1) primary
 * 2) secondary     or acquired
 * 3) Heriditery      parkinsonism, and

CAUSES
Parkinson's disease is caused by the progressive impairment or deterioration of neurons (nerve cells) in an area of the brain known as the substantia nigra. When functioning normally, these neurons produce a vital brain chemical known as dopamine. Dopamine serves as a chemical messenger allowing communication between the substantia nigra and another area of the brain called the corpus striatum. This communication coordinates smooth and balanced muscle movement. A lack of dopamine results in abnormal nerve functioning, causing a loss in the ability to control body movements.

Why Parkinson's disease occurs and how the neurons become impaired is not known. However, there is increasing evidence that Parkinson's disease may be inherited (passed on genetically from family members).

There is considerable controversy surrounding the possibility of a genetic cause of Parkinson's disease. In a small number of families, specific genetic abnormalities leading to the illness have been identified. However, the vast majority of people with Parkinson's disease do not have one of these identified genetic abnormalities. It is probable that in people who develop Parkinson's disease early in life (called young-onset Parkinson's disease) there is a genetic component. Because we don't understand very much at this point about how Parkinson's disease is inherited, the implications for children of people with Parkinson's disease are unclear.

There is also some evidence that certain toxins in the environment may cause Parkinson's disease. Scientists have suggested that external or internal toxins may selectively destroy the dopaminergic neurons, causing Parkinson's disease. Toxins that may be linked to Parkinson's include manganese, carbon monoxide, carbon disulfide, and some other pesticides.

Also, it is believed that oxidative stress can cause Parkinson's disease. Oxidation is a process in which free radicals (unstable molecules lacking one electron), in an attempt to replace the missing electron, react with other molecules (such as iron). Free radicals are normally formed in the brain and body, but usually the brain and body have mechanisms to get rid of them. In people with Parkinson's disease, the mechanisms may not be effective or they may produce too many free radicals. It is also possible that environmental toxins may contribute to abnormal free radical formation and lead to Parkinson's disease. Oxidation is thought to cause damage to tissues, including neurons. In most cases, antioxidants protect cells from free radical damage.

SIGNS AND SYMPTOMS
Parkinson's disease symptoms and signs may vary from person to person. Early signs may be mild and may go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.

Parkinson's signs and symptoms may include:
 * Tremor. A    tremor, or shaking, usually begins in a limb, often your hand or fingers.     You may notice a back-and-forth rubbing of your thumb and forefinger,     known as a pill-rolling tremor. One characteristic of Parkinson's disease     is a tremor of your hand when it is relaxed (at rest).
 * Slowed    movement (bradykinesia). Over time, Parkinson's disease may     reduce your ability to move and slow your movement, making simple tasks     difficult and time-consuming. Your steps may become shorter when you walk,     or you may find it difficult to get out of a chair. Also, you may drag     your feet as you try to walk, making it difficult to move.
 * Rigid    muscles. Muscle stiffness may occur in any part of your body. The     stiff muscles can limit your range of motion and cause you pain.
 * Impaired    posture and balance. Your posture may become stooped, or you may     have balance problems as a result of Parkinson's disease.
 * Loss of    automatic movements. In Parkinson's disease, you may have a     decreased ability to perform unconscious movements, including blinking,     smiling or swinging your arms when you walk.
 * Speech    changes. You may have speech problems as a result of Parkinson's     disease. You may speak softly, quickly, slur or hesitate before talking.     Your speech may be more of a monotone rather than with the usual     inflections.
 * Writing    changes. It may become hard to write, and your writing may appear     small.

risk factors and complications
Parkinson's disease is often accompanied by these additional problems, which may be treatable: ·        Depression and emotional changes. People with Parkinson's disease may experience depression. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease.
 * Age. Young    adults rarely experience Parkinson's disease. It ordinarily begins in     middle or late life, and the risk increases with age. People usually     develop the disease around age 60 or older.
 * Heredity. Having    a close relative with Parkinson's disease increases the chances that     you'll develop the disease. However, your risks are still small unless you     have many relatives in your family with Parkinson's disease.
 * Sex. Men    are more likely to develop Parkinson's disease than are women.
 * Exposure    to toxins. Ongoing exposure to herbicides and pesticides may put     you at a slightly increased risk of Parkinson's disease
 * Thinking    difficulties. You may experience cognitive problems (dementia)     and thinking difficulties, which usually occur in the later stages of     Parkinson's disease. Such cognitive problems aren't very responsive to     medications.

You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. ·        Sleep problems and sleep disorders. People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.
 * Swallowing    problems. You may develop difficulties with swallowing as your     condition progresses. Saliva may accumulate in your mouth due to slowed     swallowing, leading to drooling.

People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems. You may also experience:
 * Bladder    problems. Parkinson's disease may cause bladder problems, including     being unable to control urine or having difficulty urinating.
 * Constipation. Many    people with Parkinson's disease develop constipation, mainly due to a     slower digestive tract.
 * Blood    pressure changes. You may feel dizzy or lightheaded when you     stand due to a sudden drop in blood pressure (orthostatic hypotension).
 * Smell    dysfunction. You may experience problems with your sense of     smell. You may have difficulty identifying certain odors or the difference     between odors.
 * Fatigue. Many    people with Parkinson's disease lose energy and experience fatigue, and     the cause isn't always known.
 * Pain. Many    people with Parkinson's disease experience pain, either in specific areas     of their bodies or throughout their bodies.
 * Sexual    dysfunction. Some people with Parkinson's disease notice a     decrease in sexual desire or performance.

DIAGNOSIS
Often, the diagnosis of Parkinson’s is first made by an internist or family physician. Many people seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of Parkinson’s disease — referred to as a movement disorder specialist.

To diagnose Parkinson’s, the physician takes a careful neurological history and performs an examination. There are no standard diagnostic tests for Parkinson’s, so the diagnosis rests on the clinical information provided by the person with Parkinson’s and the findings of the neurological exam. There is no standard diagnostic test for Parkinson’s. Researchers are working to develop an accurate “biological marker,” such as a blood test or an imaging scan. To date, the best objective testing for PD consists of specialized brain scanning techniques that can measure the dopamine system and brain metabolism. But these tests are performed only in specialized imaging centers and can be very expensive.
 * The doctor    looks to see if your expression is animated.
 * Your arms    are observed for tremor,     which is present either when they are at rest, or extended.
 * Is there    stiffness in your limbs or neck?
 * Can you    rise from a chair easily?
 * Do you    walk normally or with short steps, and do your arms swing symmetrically?     The doctor will pull you backwards.
 * How    quickly are you able to regain your balance?

PREVENTION
Caffeine consumption is associated with a reduced risk of Parkinson’s disease in men but not in women. This gender difference may be due to an interaction between caffeine and use of postmenopausal estrogen. The authors prospectively assessed the relation between coffee consumption and Parkinson’s disease mortality among participants in the Cancer Prevention Study II, a cohort of over 1 million people enrolled in 1982. Causes of deaths were ascertained through death certificates from January 1, 1989, through 1998. Parkinson’s disease was listed as a cause of death in 909 men and 340 women. After adjustment for age, smoking, and alcohol intake, coffee consumption was inversely associated with Parkinson’s disease mortality in men (ptrend = 0.01) but not in women (p = 0.6). In women, this association was dependent on postmenopausal estrogen use; the relative risk for women drinking 4 or more cups (600 ml) of coffee per day compared with nondrinkers was 0.47 (95% confidence interval: 0.27, 0.80; p = 0.006) among never users and 1.31 (95% confidence interval: 0.75, 2.30; p = 0.34) among users. These results suggest that caffeine reduces the risk of Parkinson’s disease but that this hypothetical beneficial effect may be prevented by use of estrogen replacement therapy.

Physical activity is often part of the recommended treatment for Parkinson's, especially early in the disease. Dr. Edward Wolpow, a neurologist at Harvard-affiliated Mount Auburn Hospital in Cambridge, Mass., and a member of the Health Letter 's editorial board, urges his patients with early Parkinson's to work on building up their strength, balance, and endurance, "because they will be needed later on." People with Parkinson's often receive targeted physical therapy, but they may also benefit from many other types of exercise and overall physical fitness. Exercise — especially if it's aerobic, or gets the heart beating faster — seems to have a protective effect on brain tissue. There are fewer findings specific to Parkinson's, but studies have found that people with the disease who are in good cardiovascular shape score better on thinking and muscle control tests and may live longer.

PROGRESSION
The progression of Parkinson’s disease varies among different individuals. Parkinson's is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years. Parkinson's is not considered a fatal disease. And the way that it progresses is different for everyone:
 * Movement    symptoms vary from person to person, and so does the rate at which they     progress.
 * Some are    more bothersome than others depending on what a person normally does     during the day.
 * Some    people with Parkinson's live with mild symptoms for many years, whereas     others develop movement difficulties more quickly.
 * Nonmotor symptoms also    are very individualized, and they affect most people with Parkinson's at     all stages of disease.  Some people with Parkinson's find that     symptoms such as depression or fatigue interfere more with daily life than     do problems with movement.

Rating Scales
That said, there are tools that your doctor may use to understand the progression of your Parkinson's. The stages of Parkinson's correspond both to the severity of movement symptoms and to how much the disease affects a person’s daily activities. The most commonly used rating scales are focused on the motor symptoms, but new scales include information on non-motor symptoms (such as problems with sense of smell).
 * 1)  The    first, known as Hoehn and Yahr, will rate your symptoms on a scale of 1 to     5.  On this scale, depending on a person’s difficulties, 1 and 2     represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage     Parkinson's.
 * 2) Another     scale commonly used to assess the progression of Parkinson's is the United     Parkinson’s Disease Rating Scale (UPDRS).  It is more comprehensive     than the Hoehn and Yahr scale, which focuses on movement symptoms.      In addition to these, the UPDRS takes into account cognitive difficulties,     ability to carry out daily activities, and treatment complications.

Severity of Parkinson's
Below are some descriptions of mild, moderate and advanced Parkinson's. As disease progresses differently in different people, many do not progress to the advanced stage.

Mild Parkinson’s Moderate Parkinson’s Advanced Parkinson’s
 * Movement    symptoms may be inconvenient, but do not affect daily activities
 * Movement    symptoms, often tremor,     occur on one side of the body
 * Friends    may notice changes in a person’s posture, walking ability or facial     expression
 * Parkinson's    medications suppress movement symptoms effectively
 * Regular    exercise improves and maintains mobility, flexibility, range of motion and     balance, and also reduces depression and constipation
 * Movement    symptoms occur on both sides of the body
 * The body    moves more slowly
 * Trouble    with balance and coordination may develop
 * “Freezing”    episodes — when the feet feel stuck to the ground — may occur
 * Parkinson's    medications may “wear off” between doses
 * Parkinson's    medications may cause side     effects, including dyskinesias (involuntary movements)
 * Regular    exercise, perhaps with physical therapy, continues to be important for     good mobility and balance
 * Occupational    therapy may provide strategies for maintaining independence
 * Great    difficulty walking; in wheelchair or bed most of the day
 * Not able    to live alone
 * Assistance    needed with all daily activities
 * Cognitive    problems may be prominent, including hallucinations and delusions
 * Balancing    the benefits of medications with their side effects becomes more     challenging

Deep Brain Stimulation
DBS surgery was first approved in 1997 to treat Parkinson’s disease tremor, then in 2002 for the treatment of advanced Parkinson's disease symptoms. More recently, in 2016, DBS surgery was approved for the earlier stages of Parkinson's, for those with at least four years disease duration and with motor complications that are not adequately controlled with medication.

In deep brain stimulation, surgery is performed to insert electrodes into a targeted area of the brain, using MRI and recordings of brain cell activity during the procedure. A second procedure is performed to implant an impulse generator or IPG (similar to a pacemaker) under the collarbone or in the abdomen. The IPG provides an electrical impulse to a part of the brain involved in motor function. Those who undergo DBS surgery are given a controller to turn the device on or off.

DBS is certainly the most important therapeutic advancement since the development of levodopa. It is most effective for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesias, with studies showing benefits lasting at least five years. That said, it is not a cure and it does not slow PD progression. It is also not right for every person with PD.

Like all brain surgeries, DBS carries a small risk of infection, stroke, bleeding or seizures. DBS surgery may be associated with reduced clarity of speech. A small number of people with PD have experienced cognitive decline after DBS surgery.

It is very important that a person with PD who is thinking of DBS surgery be informed about the procedure and realistic in his or her expectations.

Carbidopa/Levodopa Enteral Suspension (Duopa™)
Carbidopa/levodopa enteral suspension (Duopa™) is a gel formulation of the gold-standard drug used to treat the motor symptoms of Parkinson’s. It is indicated for the treatment of motor fluctuations in advanced Parkinson’s.

The drug is delivered to the small intestine through a tube in the stomach. Surgery is required to place a small hole in the stomach that allows for drug delivery.

DUOPA™ uses the same active ingredients as orally-administered carbidopa/levodopa, but is designed to improve absorption and reduce off-times by delivering the drug directly to the small intestine.

Like any surgery, the procedure carries risks, as does use of the device that delivers the drug. These include movement or dislocation of the tube, infection, redness at the insertion point, pancreatitis, bleeding into the intestines, air or infection in the abdominal cavity, and failure of the pump. The drug may also lead to side effects. The drug is contraindicated for those taking non selective monoamine oxidase (MAO) inhibitors

HISTORY
Parkinson's is a condition that has been known about since ancient times. It is referred to in the ancient Indian medical system of Ayurveda under the name Kampavata. In Western medical literature it was described by the physician Galen as "shaking palsy" in AD 175. However it was not until 1817 that a detailed medical essay was published on the subject by London doctor James Parkinson.

The publication was entitled "An Essay on the Shaking Palsy". This established Parkinson's disease as a recognised medical condition. The essay was based on six cases he had observed in his own practise and on walks around his neighbourhood. The essay was intended to encourage others to study the disease. Some 60 years after it was first published, a French neurologist by the name of Jean Martin Charcot did exactly that. Charcot was the first to truly recognise the importance of Parkinson's work and named the disease after him.

Much has been learned about the disease yet much remains a mystery. The symptoms are progressive and degenerative and tend to be more common in older individuals. It is understood that a dopamine deficiency in the brain is at the root of the matter, yet why this initially occurs is less clear.

It was in the 1960s that that the chemical differences in the brains of Parkinson's patients were identified. The low levels of dopamine cause the degeneration of nerve cells in part of the brain called the substantia nigra. It was this discovery that lead to the first effective medicinal treatment of the disease. In the 1960s the drug Levodopa was first administered to treat the symptoms and has since become the "gold standard" in medication.

Since the 1960's research has continued to progress at a rapid rate. Despite the fact there is still no cure, the symptoms can now be effectively controlled and reduced in severity. The Parkinson's Disease Foundation was established in America in1957 to assist sufferers and to fund and promote further research. Many other foundations assisting the cause have been established in the following years. A notable recent addition is the Michael J Fox Foundation, named after the much loved television and movie actor. The foundation has been very public about its goal of developing a cure for the disease within this decade. Since its inception in 2000 it has succeeded in raising over 90 million US dollars.

Progress on all fronts is gaining momentum. Hope for the future of the "Shaking Palsy", it seems, is decidedly solid.

AWARENESS: FAMOUS PEOPLE WITH THE DISEASE,BOOKS AND MOVIES RELATED
FAMOUS PEOPLE WITH THE DISEASE

1.      Michael J. Fox

2.      Robin Williams

3.      Muhammad Ali

4.      Johnny Cash 5.      Estelle Getty

BOOKS RELATED :
 * ·        An Illustrated Pocketbook of Parkinson's Disease and Related Disorders


 * ·        With Shaking Hands: Aging with Parkinson's Disease in America's Heartland


 * ·        Pesticides and Parkinson's Disease-Is There a Link?


 * ·        Clinical Psychopharmacology: A Primer

MOVIES :
 * ·        Saving Milly: Love, Politics, and Parkinson's Disease

1.      LOVE AND OTHER DRUGS

2.      A LATE QUARTET

3.      AWAKENINGS